The Impact of Demographics and Comorbidities on Fall Incidence and Prevalence in Older Adults

Abstract Introduction : Falls among older adults are more than mere accidents; they are a silent epidemic, profoundly impacting the health and well-being of millions of older adults worldwide. This study examines the incidence and prevalence of falls among individuals aged 65 and above, focusing on the influence of demographic factors and comorbid conditions such as hypertension, diabetes mellitus, cancer, and obesity. Methods: A retrospective cohort study was conducted using data from the TriNetX network at Virginia Commonwealth University Health System (VCUHS) from 2019 to 2023. The study population included 16,400 individuals aged 65 and above who presented with fall-related trauma. Data on demographics, clinical diagnoses, procedures, and comorbid conditions were analyzed using descriptive statistics to evaluate the incidence and prevalence of falls. Results: The mean age of the study population was 77.3 years, with a higher proportion of females (60.97%) compared to males (39.02%). Despite the larger number of female participants, incidence and prevalence of falls were highest among individuals aged 65-69 years, and fall rates were notably higher among males compared to females. This suggests that while fewer in number, males in our study experienced falls more frequently. Patients with hypertension had the highest incidence proportion (56.67%) and prevalence (75.75%) among comorbid conditions. Conclusions: Falls among older adults are significantly influenced by demographic factors and comorbid conditions. Hypertension, in particular, is associated with the highest fall risk. These findings highlight the need for targeted interventions to manage comorbidities and reduce fall risks among older adult patients.

older adults fall patients are affected, and treatments such as chemotherapy can lead to muscle weakness, fatigue, and neuropathy, all of which increase susceptibility to falls 20 .Moreover, corticosteroid use, often prescribed for cancerrelated conditions, has been linked to adverse fall outcomes, particularly among hypertensive patients, exacerbating fall risks due to muscle wasting and bone loss 21,22 .Falls among older adults not only pose a signi cant risk for injury but also underscore a mounting public health challenge indicative of underlying gaps in geriatric health management and preventive care.This retrospective study investigates the incidence and prevalence of falls over the past four years using data extracted from the TriNetX network Virginia Commonwealth University-Health System VCUHS database spanning from 2019 to 2023.With ethical approval secured, the study analyses a cohort of 16,400 individuals aged 65 and above who were presented at hospitals with fall-related trauma.By examining the demographics, including age, gender, ethnicity and racial distribution, alongside comorbidities and risk factors associated with these incidents, this research aims to explore incidence and prevalence of falls related trauma.The ndings from this project are critical for developing targeted interventions to reduce the frequency and severity of falls among the older adults.These results will be used to re ne fall risk assessments and to shape effective strategies for intervention at both the individual and community levels.

Method Study Design
A retrospective cohort study utilizes data extracted from the TriNetX network VCU database, encompassing 16,400 participants from January 1st, 2019 to December 31st, 2023.The study aims to evaluate the incidence and prevalence of falls among older adults aged 65 years and above who are presented at hospitals with fall-related trauma.

Data Source
Data for this retrospective cohort study was obtained from the TriNetX network at Virginia Commonwealth University Health System (VCUHS), which aggregates electronic health records (EHRs) exclusively from within the VCUHS network.This database serves as a comprehensive repository of patient information, including demographics such as age, gender, ethnicity and race.These demographic details are used to characterize the study population of older adults aged 65 years and above who experienced fall-related trauma.Clinical diagnoses documented in the EHRs provide insights into prevalent health conditions and comorbidities among the cohort, including hypertension, obesity, diabetes mellitus, and cancer, all of which in uence fall risk and outcomes.Procedures recorded in the database illuminate the medical interventions and treatments administered to patients following fall-related injuries, offering context for understanding healthcare management strategies and utilization patterns.

Data Handling and Analysis
The richness of data within the TriNetX network 23 facilitated robust statistical analysis.Descriptive statistics were employed to characterize the study population, detailing variables such as age, gender, race, and the prevalence and incidence rate of comorbid conditions.These statistics included means, medians, standard deviations, and frequency distributions.The prevalence and incidence functions on the TriNetX platform were utilized to accurately capture and analyze these metrics, providing a comprehensive overview of the study population's health status and the impact of comorbid conditions on fall risk.Additionally, patients were identi ed through ICD-10 codes related to fall injuries, ensuring accurate classi cation and analysis of fall-related trauma cases.

Demographics
The study population consisted of 16,400 individuals aged 65 years and above, with a mean age of 77.3 years (SD ± 8.07), who were presented with fall-related trauma.Gender distribution showed that 60.97% (10,000) of the patients were female, while 39.02% (6,400) were male, with a small fraction (0.06%, or 10 individuals) having an unknown gender.In terms of ethnicity, a vast majority, 96.4% (15,810), were not Hispanic or Latino, 3.04% (500) were Hispanic or Latino, and 0.6% (100) had unknown ethnicity.
Regarding race, 62.92% (10,320) of the patients were White, 31.58%(5,180) were Black or African American, 2.92% (480) were Asian, 0.6% (100) were American Indian or Alaska Native, and 0.18% (30) were Native Hawaiian or Other Paci c Islander.Additionally, 1.89% (310) of the patients identi ed as another race.This demographic distribution provides a comprehensive overview of the study population, highlighting the diversity and prevalent characteristics within the older adult cohort who experienced falls (Tables 1).groups.Gender analysis revealed that males had a higher incidence proportion (24%) and prevalence (40.44%) compared to females.In terms of racial strati cation, American Indian or Alaska Native individuals had the highest rates with an incidence proportion of 50% and prevalence of 66.67%.Ethnicity-wise, Hispanic or Latino individuals exhibited a high incidence rate of 6.56 cases per 1,000 person-days, matching a prevalence of 30%.(Table 3).Other Paci c Islander individuals showing an incidence and prevalence of 100%, and the highest incidence rate of 10.17 per 1,000 person-days.Hispanic or Latino patients also showed higher rates compared to non-Hispanic or Latino, emphasizing the variability across different ethnic and racial groups (Table 3).

Incidence and Prevalence of Falls among Patients with High Weight/Obesity
The incidence proportion of high Weight/Obesity is 16.11% with prevalence of 29.88%, with an incidence rate of 1.65 per days.Ethnic variations also showed that Hispanic or Latino individuals had a notably lower incidence proportion and prevalence of 10%, while Non-Hispanic or Latino individuals reported higher gures.These ndings underscore the varying impact of obesity on fall risks across different demographic groups (Table 3).

Summery
The study examined the incidence and prevalence of falls among patients with various comorbidities, including cancer, diabetes mellitus, hypertension (HTN), and high weight/obesity.Among the fall patients, those with hypertension had the highest incidence proportion at 56.67% (0.5667396), with a prevalence of 75.75% (0.75750154) and an incidence rate of 0.94 cases per person-day (0.0009408766).Patients with cancer showed an incidence proportion of 23.71% (0.23707958), a prevalence of 43.11% (0.4311084), and an incidence rate of 0.26 cases per person-day (0.000264396).
For those with diabetes mellitus, the incidence proportion was 21.21% (0.21205008), with a prevalence of 38.33% (0.38334355) and an incidence rate of 0.22 cases per person-day (0.000220008).Patients with high weight/obesity exhibited an incidence proportion of 16.11% (0.16105418), a prevalence of 29.88% (0.2988365), and an incidence rate of 0.16 cases per person-day (0.00016495131).

Discussion
The ndings of this study underscore the signi cant impact of falls among the older adult population, highlighting critical demographic disparities and the prevalence of comorbidities.The data obtained from the TriNetX network at Virginia Commonwealth University Health System (VCUHS) provided a comprehensive overview of the incidence and prevalence of falls among individuals aged 65 and older over a ve-year period.
The demographic analysis reveals that falls are most frequent among those aged 65-69, with an incidence of 26.78% and a prevalence of 46.18%.Rates generally decrease with age.Research consistently shows that the risk of falls escalates with age, especially among individuals aged 85 and older, who are notably prone to falling 6 .
Males exhibit higher fall rates (incidence: 26.25%, prevalence: 44.54%) compared to females (incidence: 22.19%, prevalence: 42.21%).Literature indicates that women are more likely to experience falls than men, possibly due to higher rates of osteoporosis and sarcopenia contributing to frailty and balance issues 24(p3) 25,26 .
Among ethnic groups, American Indian or Alaska Native individuals show the highest fall incidence (50%) and rate (5.11 per 1,000 person-days), highlighting signi cant racial disparities.Hispanic or Latino individuals have an incidence of 22.22% and the highest rate (4.66 per 1,000 person-days), underscoring the need for targeted interventions.Studies reveal that African American and Hispanic older adult populations experience higher rates of fall-related injuries compared to their White counterparts, emphasizing signi cant disparities in fall risks among ethnic groups 27 12 .
The incidence and prevalence of falls among patients with various comorbidities, including cancer, diabetes mellitus, hypertension (HTN), and high weight/obesity.Our results indicate that among patients who experienced falls, those with hypertension had the highest incidence proportion (56.67%) and prevalence (75.75%), as well as an elevated incidence rate per person-day.Hypertension, in particular, is associated with the highest incidence and prevalence of falls, potentially due to the effects of antihypertensive medications causing dizziness and balance problems 14,18 .
Our study found that cancer patients had an incidence proportion of 23.71%, a prevalence of 43.11%, and an incidence rate of 0.26 fall cases per person-day.These results highlight a signi cant burden of fall-related incidents among cancer patients.
Similar studies support our ndings.Stone et al. reported that falls are common among cancer patients, with a prevalence and incidence rate that closely align with our data 28 .They noted that cancer treatments, increased frailty, and decreased mobility contribute signi cantly to falling risk among these patients 29 .Additionally, Capone et al. found comparable incidence rates, underscoring the widespread nature of this issue in cancer populations 30 .
The high prevalence rate observed in our study might be due to factors such as cancer treatment side effects, increased frailty, and decreased mobility among patients.The signi cant incidence proportion indicates a substantial number of new fall cases, underscoring the need for robust prevention strategies.
Our ndings, validated by existing literature, emphasize the critical need for ongoing research and effective healthcare policies to reduce fall incidence among cancer patients, ultimately improving their safety and quality of life.
In addition to our ndings on cancer patients, our study also revealed signi cant data for patients with diabetes mellitus.
Speci cally, the incidence proportion for diabetes patients was 21.21%, with a prevalence of 38.33%, and an incidence rate of 0.22 fall cases per person-day.These ndings underscore a substantial burden of fall-related incidents within the diabetic patient population.
Supporting studies show similar trends.Yang et al., conducted a systematic review and found that older adults with diabetes have a signi cantly higher risk of falls, with an annual incidence of up to 39% in older adults diabetic individuals.
This higher incidence is likely due to complications from diabetes such as neuropathy, poor glycemic control, and increased frailty, which impair balance and increase fall risk 31 .Similarly, Tinetti and Speechley observed that the risk of falls is signi cantly elevated in diabetic individuals, highlighting the need for targeted prevention strategies 32 .
The high prevalence rate in our study may be attributed to the same factors, including poor glycemic control, neuropathy, and other comorbid conditions.These complications can impair balance and mobility, thereby increasing the risk of falls 33 .The signi cant incidence proportion indicates a substantial number of new fall cases, emphasizing the urgent need for effective fall prevention strategies speci cally tailored for diabetic patients.

Limitation
This retrospective study faces multiple limitations that may affect the interpretation of its ndings.Firstly, the reliance on electronic health records (EHRs) could introduce biases related to incomplete or inaccurate data entries and variations in documentation practices across different providers.Additionally, the use of ICD-10 codes for data extraction might not fully capture the clinical context, possibly leading to misclassi cation errors.Due to its retrospective design, the study is unable to establish causal relationships.
Another signi cant limitation is the geographic and institutional restriction of the data to the Virginia Commonwealth University Health System (VCUHS), which may limit the generalizability of the results to other settings.The study also did not account for variables such as the severity of comorbidities and socio-economic factors, which could in uence the outcomes, thereby limiting the comprehensiveness of the analysis.
Importantly, the time period of data extraction did not explicitly account for the impact of the COVID-19 pandemic.The years 2020 and 2021 saw a notable decrease in reported falls, likely due to increased reluctance to leave home and the presence of more caregivers at home to assist the elderly.This trend might signi cantly skew the data, representing a critical limitation for this study period.

Conclusion
The study the critical impact of comorbid conditions such as hypertension, cancer, diabetes mellitus, and obesity on the incidence and prevalence of falls.Hypertension patients were most affected, exhibiting the highest incidence and prevalence rates.The data reveals a clear correlation between these comorbidities and increased fall risks, necessitating targeted preventive strategies and interventions.By addressing these underlying health issues, healthcare providers may have the opportunity to mitigate fall risks, potentially enhancing patient safety and quality of life.However, it is important to note that our study does not conclusively prove this relationship, and further research is needed to establish direct causal links.

Table 2
Incidence and Prevalence of Falls Strati ed by Demographics Diabetes Mellitus Type II incidence proportion was 21.21% with a prevalence of 38.33% and an incidence rate of 2.20 cases per 1,000 person-days.Age-speci c analysis showed a gradual decrease in incidence proportion from 22.49% in the 65-69 age group to 16.88% in those 85 and older.Similarly, prevalence and incidence rates varied slightly across age

Table 3
Comorbidities Strati ed Results by DemographicsThe incidence and prevalence of falls among hypertensive patients, revealing that 56.67% experienced at least one fall, with a prevalence of 75.75% and a high incidence rate of 9.41 per 1,000 person-days.Older age groups, particularly those aged 85 and older, displayed the highest gures: a 65.14% incidence and 80% prevalence.Males showed a greater incidence (62.01%) and prevalence (78.68%) compared to females.Racially, Native Hawaiian or Other Paci c Islander individuals recorded the highest rates, both at 100%, with a notably high incidence rate of 29.33 per 1,000 person-days.Among ethnic groups, Hispanic or Latino individuals reported a 60% incidence and prevalence, demonstrating signi cant variations across demographics in the impact of hypertension on fall risk.(

Table 3 )
Incidence and Prevalence of Falls among Patients with CancerThe incidence proportion of falls among Patients with Cancer is 23.83% and a prevalence of 43.19%, with an incidence rate of 2.63 per 1,000 person-days.Incidence rates were highest among those aged 65-69 years at 26.67% and gradually decreased with age, with the lowest rates observed in individuals 85 and older.Males displayed higher rates compared to females, with a 26.40% incidence and 44.53% prevalence.Racial disparities were pronounced, with Native Hawaiian or 34so, we examined patients with high weight/obesity, nding an incidence proportion of 16.11%, a prevalence of 29.88%, and an incidence rate of 0.16 cases per person-day.Supporting studies align with our ndings.Mitchell et al. reportedthat obesity increases fall risk due to factors such as decreased mobility and joint instability, reinforcing the need for targeted fall prevention strategies in obese populations34.These ndings highlight the signi cant impact of comorbid conditions on the risk of falls, emphasizing the need for targeted interventions to manage these comorbidities and reduce fall risk among older adult patients.StrengthThis study has several notable strengths.Utilizing a large and diverse dataset from the TriNetX network at Virginia Commonwealth University Health System (VCUHS) allows for robust analysis with signi cant sample size, enhancing statistical power and reliability.The use of standardized ICD-10 codes for data extraction ensures consistency and accuracy in identifying diagnoses and comorbidities, minimizing misclassi cation risk and improving validity.Covering a ve-year period, the study provides a longitudinal perspective on the incidence and prevalence of falls among the older adults, allowing for trend observation over time.Additionally, detailed strati cation by age, gender, race, and ethnicity identi es high-risk groups, supporting targeted interventions and policies to reduce fall risk and improve outcomes for older adults' individuals.